CPT code 45309 is a medical billing code for the procedure of removing tissue during a proctosigmoidoscopy.
CPT code 45309 is for a proctosigmoidoscopy procedure that involves the removal of tissue or polyps from the rectum or lower part of the colon. This procedure allows healthcare providers to visually examine the rectum and sigmoid colon using a flexible tube with a light and camera, and it includes the specific action of removing abnormal growths or lesions during the examination.
For CPT code 45309, which pertains to proctosigmoidoscopy removal, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or other factors that increased the complexity of the procedure.
2. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
3. Modifier 53 - Discontinued Procedure: Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threatened the well-being of the patient.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same procedure was repeated by the same physician.
6. Modifier 77 - Repeat Procedure by Another Physician: Apply this modifier if the same procedure was repeated by a different physician.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used if the patient had to return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 99 - Multiple Modifiers: Apply this modifier if multiple modifiers are needed to describe the service provided.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 45309 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, reimbursement may vary depending on factors such as the specific Medicare Administrative Contractor (MAC) for your region and any applicable local coverage determinations. Providers should consult their MAC for detailed information on coverage and payment policies for this code.
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